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  • Jake Miller PTA

LSVT BIG For Treatment of Parkinson’s Disease

If you have read the previous blog posts about Parkinson’s Disease and treatment options, you may be aware of physical therapy’s role in treatment. If you have not read the previous 2 blog posts, I highly recommend that you return to our blog page and read them prior to continuing with this post. As you have already read, there are many ways to assist with treating Parkinson’s, but one specific and very useful treatment approach to Parkinson’s Disease is LSVT BIG.


LSVT BIG is a research-based exercise approach developed from principles of the effective Parkinson’s specific speech treatment: LSVT LOUD.


As stated above, LSVT BIG is derived from LSVT LOUD. Not only was this treatment derived from another treatment, but it was also named after it. “LSVT” stands for Lee Silverman Voice Treatment. Lee Silverman was the first patient that “tested” a new speech therapy program in 1987 with hopes that it would allow her to speak more clearly to her family. The goal was simple: retrain Lee’s speech to allow her to communicate with her family – and that’s exactly what happened. In fact, it was such a success that it was developed into the modern treatment of LSVT LOUD. As the years passed, speech therapy for Parkinson’s improved and LSVT BIG was formed to address more of the physical struggles associated with Parkinson’s. Although two separate treatments and separate goals, the principles are the same.

LSVT BIG Principles:

LSVT BIG treatment is Neurorehab.

This form of treatment is not traditional physical/occupational therapy but therapy rather focused on amplitude. Amplitude in this sense is defined as: one’s ability to move in a small or big manner. Based on the name I would bet you can guess what LSVT BIG focuses on – big amplitude/movements. Amplitude is one of the most important bases for Parkinson’s treatment as this allows one to move with greater easy and quality resulting in a decreased fall risk and improved functional independence. Improvements in amplitude addresses one of the most common signs of Parkinson’s – a shuffling gait pattern.

Often ones amplitude can become so poor, you might wonder, how do you improve someone’s amplitude if they are already struggling with basic movements (walking) that we all take for granted. The answer is through the second principle: Mode of training.

When teaching someone to move in a bigger manner, in order for it to be successful, it must be in an intensive and high effort way. Furthermore, not only must you perform a particular movement with high effort but it must be completed multiple times to allow for change in amplitude. For example: you wouldn’t expect your muscle tone to change after only exercising one time and barely breaking a sweat. In order to make change, the body requires consistent high effort work, which is no different when it comes to Parkinson’s. Doing something that challenging and requiring a lot of effort allows for a change at the neural level, which brings us to another principle – Calibration

Once someone’s amplitude is increased and improved, it’s time to work on calibration. Calibration is defined as: “The patient knows and accepts the amount of effort needed to consistently produce bigger and normal amplitude movements”. I often refer to this principle as the “Ah ha!” moment. When someone reaches this state, they start to automatically correct their movements and demonstrate improved awareness. Ultimately, improved awareness leads to improved mobility and decreased risk of falls. Calibration is the last principle of LSVT and ultimately is the principle that allows for long term change and success. Let’s talk about what LSVT BIG treatment looks like next.

What to Expect:

Achieving the principles above does not come overnight. Like the old saying goes: Good things come with time. A classic LSVT BIG treatment lasts approximately 1 hour which is packed full of feedback, one-on-one attention, and intensity from start to finish. I always get the question of “How intense is it?” every time I talk about LSVT BIG. The short answer is: As intense as you can handle. For example, I would not expect someone that can hardly stand to perform 6 standing exercises to perfection; however, we will skillfully adapt the exercises with a chair to hold onto, or even have the patient perform them in sitting to assure their safety and/or tolerance. Our job when guiding someone through LSVT BIG is to assure maximal effort but also maintain maximal safety and tolerance rather than exercising a patient to the point of soreness where they cannot function the next day. Overall, each person gets a personalized treatment that follows the strict LSVT BIG principles. To recap and expand the above thoughts, each session is 1 hour long but the patient is expected to attend 4 treatment sessions a week for 4 weeks. Furthermore, during your time away from formal LSVT BIG treatments, you will be expected to complete a tailored home exercise program to build on what occurred during each treatment session.

My Personal Experience:

Due to privacy laws and regulations I cannot be specific about the experiences that I have witnessed with the LSVT BIG program but I can share some examples that I have seen in our clinic following the LSVT BIG program:

• The ability to stand up without use of hands

• The ability to button a shirt in a reasonable time and efficient manner

• The ability to walk without scuffing the floor

• The ability to transfer in and out of a car without difficulty

• The ability to return to community activities such as grocery shopping and church

• The ability to transfer to the ground and return to standing

• The ability to play with grandchildren once again


To summarize, LSVT BIG is an intense program that is tailored to one’s ability, need, and deficits to allow for improved functional mobility, balance, and tolerance to activities of daily living. The program is based on principles of amplitude and calibration allowing for long term changes and success. Each session is filled with one on one feedback and guidance to assure the quality and appropriateness of treatment. I encourage anyone with Parkinson’s, or anyone that may know someone with Parkinson’s, to reach out and give this program a try. It can be adapted for anyone and is changing the way we approach Parkinson’s disease. This blog is by no means all-inclusive and a certified LSVT BIG clinician such as myself (Jacob Miller) or my colleague (Laurel Sampson) are always available to answer any further questions or concerns you may have about treatment of Parkinson’s with physical therapy.

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